Clinical Features of Pulmonary Embolism

Manganelli, D.; Palla, Antonio; Donnamaria, V.; Giuntini, C.

doi:10.1378/chest.107.1_supplement.25s

Cited by 92 publications

(46 citation statements)

References 52 publications

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“…In contrast, patients with pulmonary embolism, whose DD level may be high, usually do not have elevated systolic blood pressure. 26 Thus, we may be able to differentiate pulmonary embolism from AAD in terms of blood pressure, although we could not distinguish TAA/AAA rupture or hypotension from AAD in the present study. Other diseases associated with DD elevation, such as disseminated intravascular coagulopathy, liver cirrhosis, fulminant hepatitis, malignancy, and burn, also do not always present with elevated systolic blood pressure.…”

Section: Circulation Journal Vol69 April 2005contrasting

confidence: 65%

A Rapid Bedside D-Dimer Assay (Cardiac D-Dimer) for Screening of Clinically Suspected Acute Aortic Dissection

Akutsu

Sato

Yamamoto

et al. 2005

Circ J

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cute aortic dissection (AAD) can be fatal and should be diagnosed as early as possible. Without treatment, mortality increases by 1% per hour during the first 48 h. 1 Acute aortic dissection has traditionally been diagnosed by computed tomography (CT) because a rapid laboratory test has not been available. However, if the possibility of AAD could be ruled out, contrast-enhanced CT, which is time-consuming and impairs renal function with contrast media, would be unnecessary. Both the coagulation and fibrinolytic systems are reportedly activated in cases of AAD. 2 Weber et al found that assay of D-dimer (DD), a specific degradation product of cross-linked fibrin, had 100% sensitivity but only 69% specificity for detection of AAD. 3 A rapid bedside DD assay (Cardiac D-dimer, Roche Diagnostics, Mannheim, Germany) was recently developed for detection of pulmonary embolism and deep vein thrombosis. 4,5 One characteristic of patients with AAD is elevated systolic blood pressure, 1 and we hypothesized that elevated blood pressure could serve as a diagnostic indicator in cases of suspected AAD. Therefore, the first goal of the present study was to show the utility of rapid bedside DD assay in the detection of AAD. The second goal was to clarify whether positive predictive value could be increased if the rapid bedside DD assay value and blood pressure reading upon admission were used in combination. Circulation Journal Vol.69, April 2005 Methods PatientsThe study group included consecutive patients in whom AAD was suspected or not ruled out, who were admitted to the coronary care unit during the period November 2002 through June 2004 and in whom the DD level was determined by rapid bedside assay. Acute aortic dissection was suspected in patients with sudden onset of chest and/or back pain and no definitive electrocardiographic findings of Background A rapid laboratory test for diagnosis of acute aortic dissection (AAD) has not been available. We performed this prospective study to determine the utility of a rapid bedside D-dimer (DD) assay for detection of AAD. Methods and ResultsPatients with suspected AAD were recruited and their DD levels were measured by rapid bedside assay. They were divided into 2 groups according to enhanced computed tomography findings: an AAD group (n=30) and a non-AAD group (n=48). The median DD level was higher in the AAD group (1.80 g/ml) than in the non-AAD group (0.42 g/ml) (p=0.000). The rapid bedside DD assay showed 100% sensitivity, 54% specificity, 58% positive predictive value and 100% negative predictive value for detection of AAD with a normal DD level of up to 0.5 g/ml. The combination of DD level >0.5 g/ml and systolic blood pressure ≥180 mmHg showed 86% positive predictive value for detection of AAD.Conclusions We conclude that the rapid bedside DD assay is a highly sensitive method for early exclusion of AAD in patients with chest and/or back pain suggestive of AAD. Acute aortic dissection is highly probable if a rapid DD assay shows the elevated DD level with systolic blood press...

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Section: Circulation Journal Vol69 April 2005contrasting

confidence: 65%

A Rapid Bedside D-Dimer Assay (Cardiac D-Dimer) for Screening of Clinically Suspected Acute Aortic Dissection

Akutsu

Sato

Yamamoto

et al. 2005

Circ J

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“…Pulmonary embolism is a common, frequently undiagnosed, and potentially fatal cause of several common symptoms; such as dyspnea and chest pain [11][12][13][14][15]. Because PE is a fatal disease often caused by DVT, early evaluation of DVT [16] and PE [17] is important clinically.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of deep vein thrombosis by plasma-soluble fibrin or D-dimer

et al. 2005

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The present study was designed to determine the cutoff values of D-dimer and soluble fibrin (SF) for the diagnosis of deep venous thrombosis (DVT) and pulmonary embolism (PE) in Japanese patients. Plasma levels of these molecules were measured in 243 patients suspected of having DVT and 100 healthy volunteers (controls). Out of 243 patients, 20 patients were diagnosed with DVT. In the control group, plasma levels of D-dimer and SF did not show normal distribution, and the 95% confidence intervals (CI) of D-dimer and SF were 2.45 mg/mL and 6.92 mg/mL, respectively. Plasma levels of D-dimer and SF of patients with DVT were significantly higher than of those without DVT. In patients with DVT, the minimum values of D-dimer and SF were 1.71 and 1.44 mg/mL, respectively. When the cutoff value was set at the average + 1 SD of those of the control (D-dimer, about 1.8 mg/ mL; SF, about 1.4 mg/mL), 1 and 0 patient with DVT was overlooked, respectively. The sensitivity and specificity of D-dimer and SF for DVT were 95% and 100%, and 61.9% and 53.8%, respectively. When the cutoff value was set at 95% CI of the control (D-dimer, 2.5 mg/ mL; SF, 6.9 mg/mL), 2 and 9 patients with DVT were overlooked, respectively. The sensitivity and specificity of D-dimer and SF were 90% and 50%, and 77.6% and 88.3%, respectively. When the cutoff values set at 2.5 mg/mL of D-dimer or 6.9 mg/mL of SF, 1 DVT patient was overlooked, with sensitivity and specificity of 95% and 69.5%. Our data suggest that both D-dimer and SF are useful markers for the diagnosis of DVT and that measurement of both D-dimer and SF increases the sensitivity and specificity for the diagnosis of DVT/PE.

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“…O infarto pulmonar ocorre quando as arté-rias brônquicas não são capazes de promover circulação colateral para o segmento pulmonar não perfundido. Nesses casos, a hemoptise pode estar presente 46 . A dor torácica com característica de angina de peito pode ser observada nos casos graves, em que a sobrecarga aguda do VD pode provocar isquemia miocárdica secundária 3 .…”

Section: Sinais E Sintomasunclassified